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Review of "BUPA"

published 02/05/2012 | lsfell
Member since : 02/05/2012
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"BUPA - getting less than you thought!"

We have held a family BUPA health insurance for the last 10 years, but in light of recent developments, I am about to make a move away from this insurer for the following reasons:

1. Our health insurance premiums rise each year by an amount that massively outstrips inflation. Okay, I realise that as we age, we become a greater health risk to insure, but I feel that the increases go beyond this.

2. BUPA have recently claimed that the cost of providing cover is increasing. They claim that they need to curb costs. They are doing this in the following way:

Introducing an "open referral" system. This means that your GP will be unable to refer you to the person he or she thinks has a particular expertise for the condition you are suffering with. Instead, they will only be able to refer in a "generic" style - e.g. to "an orthopaedic surgeon". BUPA will select the consultant or give a limited choice of who you are allowed to see. Undoubtedly, BUPA will provide that choice based largely on economics (except perhaps where they stand to gain by providing both the insurance and the treatment - i.e. in their BUPA Health and Wellbeing Centres).

This means that if you need a hip replacement - and the most experienced hip specialist in your area is not on their limited list, you'll end up seeing someone else.....but who?

...well, in order to gain consultant recognition in recent years, BUPA have made new consultants sign up to a contract where they are unable to charge more than BUPA tell them they can have. So economically speaking, it will be in BUPA's interest to refer you on to a new and somewhat less experienced surgeon....or perhaps someone who is more of a generalist rather than one who has particular expertise in hip surgery!

You might consider that this serves the more experienced consultant right for charging more...but here are the shocking facts:

BUPA, like all insurers print a schedule of procedures which details what they are prepared to pay for each procedure. Those limits have NOT RISEN since 1992 - yes, that's a 20 year pay-freeze! During this time however, inflation has risen as well as overheads such as medical indemnity premiums! Furthermore this week, BUPA have unveiled their new schedule of procedures and have now downgraded the amounts payable for many procedures. Some limits have been reduced by over 45%. For example, if your consultant wants you to return for a follow up consultation at which he also wishes to give you a soft tissue injection - then BUPA will only reimburse the doctor £50 for this (down from £91). The consultant would be better just charging you for a follow up consultation and not mentioning the injection...but of course that will erode your outpatient benefit limit. Frankly, I am shocked by this. It costs me about the same (i.e. £50) to visit my hairdresser!

These reductions will either force more consultants off their books (further limiting choice for patients) or it will leave patients having to part fund their treatment because the insurer reimbursement will be less.If the costs of providing cover are rising, then it is not individual doctors to blame. Private hospital charges tend to form the bulk of the amounts that insurers pay out and in my opinion, this is where costs should be being controlled.

How can BUPA do this to policyholders? Well, BUPA and AXA PPP, they have 70% of the healthcare market so they think they have the power to do what they want! I should say that such sharp practice is not being implemented by the smaller insurers such as WPA or Pru Health and in the interests of fair competition, it is perhaps about time that we compared the likes of BUPA with these smaller insurers.

So as my renewal date draws near, I am looking into other quotes and those I have received so far are actually cheaper than BUPA. But for me, the important thing is that I can rest assured that with another insurer, I will see the specialist who is right for my needs without being left massively out of pocket.

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